HomeMy WebLinkAbout930 GOLDENROD DR - Building Permits(714) 754-5273 • Faz (71a) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
Job Address: 93O GOLDENROD DR
Suite:
Vicinity:
Parcel Number: 41221315
Applicanc MILLER, DALE
Address:
Owner: BORLAND, JAMES L
Address 930 GOLDENROD DR
COSTA MESA, CA
Contractoc DALE'S ROOFING
Address: 13781 NEWHOPE ST
GARDEN GROVE, CA
Zip: 92703
Arch :
Address:
Zoning: R1 R1
ISSUED BY:
Phone: 714-534-6398
Zip:
Phone:
Zip: 92626
Phone: (774)534-6398
License: 503508
Eng:
Address:
Phone:
Status: ISSUED
Applied: 08127/2001
Issued: 08/27f2001
Phone:
Zip: License: License:
SCOPE OF PERMIT
REMOVE SHAKE ROOK, INSTALL 1/2 " CDX; AND APPLY 30 YEAR COMP SHINGLES.
Plan Check: $0.00
Permit: $125.25
SMIP Res: $0.59
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $125.84
SETBACKS
ACCESSORY
PARKING
NOTES:
Froni 0- 0
Front 0-0
Existin : 0
Rear 0-0
Rear 0- 0
Required: 0
FEE SUMMARY
PLANNING 8 ZONING
LeR 0- 0
left 0- 0
Pro osed: 0
Calc Valuation:
Claim Valuation:
Righi 0- 0
Right 0- 0
ss,soo.00
$5,900.00
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 7 BO days, or if work is suspended or abandoned
for a period ol 1 BO days.
INSPEC710NS: In order for the work authorized under this permit to be considered legal, such work must comply with all epplicable codes, and all
i requlred Inspeetiona and final epproval must be obtained. Failure to obtain Inspections and final approval will result in the expiration of this permit.
� FOR WSPECTIONS CALL: (714) 7545626
ia6&a8 (8�W)
WORKERS'COMPENSAnON DECLARAnON:
I hereby ettirm under penalry of perjury one of the tollowing declaretions:
❑ I heve end will maintain e certiticate oi consent to self-Insure for workers' compensetion, es provided for by section 3700 of the Labor Code, for �ha performance ot the
work lor which t�is pertnit is issuetl.
�I have and will maintain workers' compensatlon insurance, as requiretl by section 3700 0l the Lebor Cotle, for Ne peAormence of the work for which ihis pertnit is issued.
My workers' compensatlonLIn-surence��/ry er entl pollcy number ere: - ` c� /
Carrier: �%/�I- /? / U �'TA Policy Number. ��iS �/ Y 7 G.
(lhls sechon need not be completed il Ne Oermlf Is valued ef one hundred dollers (5100) or less.)
❑ I certity that in the peRormence of e work lor whif this permit is issuetl, I shell not employ eny person in eny menner so es to became suDiect to ihe workere'
compensetlon laws ol tlpmie d e e lh�hould become subleci Io the workers' compensetlon pmvislons of$$$QQQ tion 3700 ot the Lebor Cotle, I shell lorthwith
comply with these pr Asions. ��C.{ 1�� / n 1
Applicant Slgnature: � Date: U I �
WARNINO: FAILURE TO SECUR WORKERS' WMPENSATIIXJ COVERAGE IS UNLAWFUL AND SW1LL SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND GVIL FlNES UP TOIXJE HUNDRED
TIqUSAND DOLLARE (5100,0OO�.IN ADOITION TO TME CQST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3�O60P THE LABOR CADE, IMEREST, AND ATTORNEV'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby eHirtn Ihat I em
force antl effect. Lic. a_
CONrector's Slgnature:
oi Chapter 9(commencing with Sectlon 7000) of Division 3 of Ihe B
n Cless tt
Code, and my license Is In tull
CONSTRUCTION LENDING AGENCY:
❑ I hareby aHirtn that ihere is e construction lending agency lor ihe peAormance ot the work for whlch this permit is issued. (Sec. 3097, Civil Code).
Lendels Name: Lendefs Address:
Signature: Date:
OWNER•BUILDER DECLARA710NS:
I hereby aHlrtn Ihet under penelry af perjury Ihai l em E%EMPT FROM TME CONTRACTORS LICENSE LAW for �he following reeson (Sec. 7031.5, Buslness entl Profasslans
Cotle: Any ciry or counry which requiraz e permit to construc�, elter, improve, demolis�, or repeir eny strucWre, pnar to Its issuance, also requires Ihe epplicaN far such Dartnit
to Ble a signetl stetement Ihat he or she is licensed pursuant to the pmNsions of Ihe Contractors License Lew (Chepter 9(wmmencing with Secllon 7000) of Divlsion 3 ot Ne
Business and Professions Code) or thet �e or she is e:empt therefrom end the hasis for ihe elleged exemption. Any violation of Section 7031.5 by any aOG�icant for e pertN'
subjects tha aOP�icant m a civil penalryot not more Ihan five hundred dollars ($500)J:
❑ I, es owner ot Ihe properry, or my employees with wages as their sole compensation, WILL DO THE WORK, end the structure Is not intentled or offaretl for sale (Sec.
7044, Business and Professions Code: The Contractors License Lew does not apply to an owner of property who builds or improves ihereon, and who does such work
himsetl or herself or ihrough his or her own employees, provided thai such improvements are not intended or oflered lor sale. It, however, the building or improvement is
sold within one year of completion, the owner-builder will have the burden ot proving that ha or she did not build or improve tor purpose of sale.).
❑ I, es owner of the property, am E%CLUSIVELY CONTRACTING WIT1 LICENSED CONTRAGTORS to construct ihe project (Sec. 7044, Business end Profes5ion5
Code: The contractors License Law does not appy to an owner of property who bulltls or improves thereon, end who coniracts tor such project with a contractor(s)
license pursuant to the Contractors license Laws.).
❑ I em exempt under sec.
Signatura:
Owner ID ventied by dnvers license. ❑ Ves ❑ No
Business and Professions Code for ihis reason:
Veritication at Ownership by (rype oi tlocumem, i.e. - property tax blll or deed):
DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICA710N:
Driver's License No.
Date:
Expires:
❑ I hereby certily ihat no exwvation flve (5) or more teet in depih into which e person Is requlred to dascend, wlil be made in connectlon with work euthonzed by ihis
permit, ena that no building sWcture, scattoldinp, falsework, or tlemolition or tlismantlinp thereof, will be more ihan thirty-six (36) feet hlgR (Chap. 32, Grp 2, Art 2, Sec.
341, Tltle 8, Celifornia AtlmlNstretive Cotle).
❑ As ownerbuilder, I will not employ anyone to do work which would require e Dermit from ihe Division ol Indusirial Salery, es notetl ebove, unless such person hes e
permi� �o do such work Irom the Oivision.
Signatura: Date:
Division of Industrial Salery Pertnit Number:
CERTFlCATE OF COMPLIANCE AND AUTHORVJITION OF EMRY: I cenity under penalry ot perjury ihat I have read this applicalion and state that Ihe information given is
correcL I agree to comply wlih ell state laws end ciry ordinances relating to bulltling cronsiructlon, anA authodze representatives of t�e Ciry of Costa Mesa to enter upon the
ebove-tlescnbed pmpeny lor inspeqion puryoses. I agree not to occupy or allow occupency of eny building authonzetl by this pertnit until (inel inspection.
1 ign egal Owner(s) � �� ��@ �
/v ( ��
An Or Aut�orized Applicant Date
COUE A. INSPECTIONTYPE
1618 FixeO System Flnal Fira Prevention
1266
200
201
202
203
Pool Spe Finel
Finel Re-Rool
Finel BIocWRatelning Well
Finel Fectory Fire Place
Finel Sign
204 Finel Demolition
�g ��
C:��l �1�
COOEA INSPECTIONTYPE
206 Final Mechanical
20B Finel Piumbing
210 Finel Electncal
212 Finel Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Bullding/Occupency
PeIE It�l4�
resnNs
October 4, 1977
� �
�W311�� 1i8b0i�ttOl'i6s �f ��u�� C'u�a�,, J/„�.
i.0. !OX N.))10 AIRFONT WAY . IONG BEACH, CAUF. 90801 . �iq) Iib-7155 . �I17) 67E�3386 . pII� 838�613i
�N OFFC6:
If14D 11ar1� M�epr 61nM Mw Drlrv��w f���iip
L� Ar. GNarr� tl10] !KS ��dwMAw.. �.0, b.11
�1NI V1.101f . Lep M�cA. GN. q01 ILII eL.il16
t1{�MIN�ITION: %%�S%LS
G1INITE
COMPqE3S10N TE9TS ONj('�H� CYLINDERS
Robert C. Bennett
9130 Cedar �3
Bellflower, Celifornia 90706
PROJECT SWIM POOL AND SPA
ADORESS 930 Goldenrod, Coata Mesa, California
SAMPLEFROM 2 deep 8IIa fi811� Z 8t18110W end WH11� 2 bOCCOm
/1pCNIT6CT
HI�OINH6R
Bernard C. Adams
MIX
DATE CABT
DATE TESTED
CYLINDER NO.
COMPRES310N
TOTAL LOAD, LBS.
POUND3 PER $O. IN.
COMPLIANCE
CYLINDERS
�i.2 CO 1
9/27/77
10/4/77
1
� aay8
86,000
3,040
eonrwwc�ow
Suneet Pools West, Inc.
aueconr��crow
Enterpriae Gunite Co.
SPECIFIED
STRENG7M Z�OOO
SLUMP
10/4/77
2
7 days
103,000
3,645
7 day testa comply vith apecificationa.
r+woe er
S[eve
o�arw�euTioH:
Robert C. Bennett - 3
Costa Mesa Bldg. Dep[.
osuveeeo ar
Bennett
����Y���
9�T �� 1�( (
10/4/77
3
� d8ye
io2,000
3,610
neceiveo oH
9/28/77
•u wvow�� wn� • ni�o u iw� con�minnw� � o��w�r ow euen��. • wix�no� �o� .�uc�new e� oow e. . co�� c`u•lO+'. ow •n�
��i..c�� ..o.. o. .ia�noina reaw u e��iwvio �cweinn ovw rwirri� ��rwovw� w� � c�vrou �wo��crion �o cui..t�. +�.� .u��ic �no oowu�ve�.
000-�x
CITY OF COSTA MESA
BUILDING SAFETY DEPARTMENT
Registered Deputy Building Inspector — Certificate of Compliance
Date of this Certificate 2
Building Address 9-3D /�'/i.�/l�L'�v.P � S��%s�
Owner�.��G��'�= /��EL/(.9
Contractor . %"�i,✓=� r= %— ,��/,�.r Gs,T %
;: �.
Address p/7•/ L'; �� T/G s� ,/J.PA/d6 f
P--mit No. �i'S!`J—//� Date Issued ��9 �49
To the Director of Building Safety:
I hereby certify that the following portions of work on the buildings at
the above address which required continuous inspection and which I was
employed to inspect, were inspected by me and comply with the provi-
sions of the Building Code applicable thereto.
[ ] Concrete [ j Masonry [ ] Weldi�g
[ ] Reinforced Gypsum [ ] Special Cases
Swimming Pool Size�3X 30 (I�'Gunite [] Hand Pack
Sacks of Cement ��'� Tons of Sand
�,,proximate percent of water in aggregate ��` �
This report covers work completed during week ending
R E M A R KS: A./L ,BO�Oi/✓(� ���A! �% �
fJiYd��i�',rOiPC:�G .5'E�'�/,PEL ,.�� ��_r�yr
/� �`��y`- �"UN��✓���j���/�egistered Deputy Building Inspector
9f���f�cTo.Py�OENOird �ES✓/-FS�-ame��i6,PT/ �ENiY6,�
Address 9/.� O /vrljan, iJ. ,%'.3
�6.� /�/F.P �A- r1o%G
Laboratory, �✓��/�"C �0�'6 BEAfy� Telephone 9Z0 ��7 S—
CMF 0406-46 (BU 6)
umv �rt .,......._.. .. ..,..+.... ...�.,.
10B ADDRESS 93� Goldenrod Ih
GENERAL CONTRACTOR Larwin
APNo. 12-213-15 LOT
IN� '�CTIONS
sc
GF$
WATER
ROUGM PLUMBING
PROP. SWR. LiNE Q NOUSE CON. �
SPRINKLING SVSTEM
MISCELLANEOUS
ROUGM HEATING RNO Alp CON�ITIONING
TEMP00.ARV SERViCE OW POLE
UNDERGROUND � POWER �
ROUGH WI0.1NG
TRENCMES /.� FORMS � STEEL FEINF.
FLOOR SYSTEM
BOND BEAM Q STE�L NEINFORCE ❑
SHEATHING
FRAME AND FLFSMING
LATHING - IN QUT �'
GLASTER,BAOWN COP.T
SUBCONTRACTOR
F[iZ��.9
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ce"i��!1l//.���//jLI C�i1S,"'��2� lG�!
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COSTA MESA�BUILDING-SAFETY DEPARTMENT
ZO1 p O. BOX 1200 COSTA MESA, CALIFORNIA 92626
Fo� Applicant�to Fill in Completely
BUILDING
ADORESS
OWNER arwin Southern California, Inc
MAIL
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ADDRESS 16255 Ventura Boulevard
cirv Encino, California No�986-8890
eanNCH 16255 Ventura Boulevard
ADDRESS Encinn_ C:alifornia
AflCMITEGT L81�in TE`273-4464
OR ENGINEER NO
nooaess 9100 Wilshire Boulevard, Bev. Hi
CONTRACTOR Larwin Southern Calif., Inc.
ADDRE55 16255 Ventura Boulevard
TEL.
CITY Encino, California No.986-8890
LTG.Tivo. 191311 LICVNO. $-1
OFLOT 6� X 103 INOWONLO O
USE OF
EXISTING BLDG.
SI2E OF 1436 Na. aF 1
NEW BLDG. ROOMS STORIES
E%TERIOR WALL . ROOF . . . .
WORK TO BE
Construction sinele familv residence
=�8 -7-7i,Fa;�
_�,<-�Q 363'> ***1200`
APPLICATION FOR BUILDING PERMIT
BVILDING
ADDRESS
FIRE
�ZONE
APPROVE
IE NO.OF
PLANS
'ARDS APPROVED
MAIN BUIL�ING
DISTANCE BET
MAIN BLDGS.
VAR. aW
C.U.P.aW
HOLD FOR SPECTAL
OATE L �
USE OF
VARDS APP
CCESSORV
BET. MAIN &
ACGESS. BLD
DATE
I hereby acknowletl8e that I have reatl this application antl stace 5 J-r'
thot tha above intormetion iz correct antl agreo to comply with � '
nll laws ragulatinB builtlinp construction, nntl I shall not employ
ony p¢�son in viola[ibn oi ihe workmnn's compensa[Ion lews ot
tha Smte of Culitomla. � �
� QI huraby tortity [ha[ � em proporly Ilcensetl as.a connacror undar SQ. FT. — o
the Stam of Cnlifornta Businoss entl Profass(ons Cotle, Divisicn 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR o�
Chapter 9, antl tha[ such Iicanses are In full torto ontl et}ect, or I THE PURPOSE OF FSTABLISHING A PERMIT FEE ONIY: ¢
um axempt irOm NB p�OvisiOns of tho Stata oi Cnlitornle Business
nnd Profozslona Cotle, Division 3, Chaptar 9. VALVATION m;�
///��� ^ PERMff FEE 5 83.00 j
SiB�aturo of�' / J,' l�t M � w 5 ' E
Parmlttae ���� /�/ /!/�+iL� D. Downs ZZ 100.00 PLAN CHECK S 41 0
0
Authorizetl ABant LL
TOTAIFEE 5 LZ�+.SO
OWNER
DATE 5-19-77 -•
ESS 930 Goldenrod IIrive BUILDING PERMI
�ol �ocation .
orms
in Drain _
el R einforce
Elec. Bond _
Approval to Cover
Underground Electric _
Gas Piping Tes�
Filtering System Lines —
Backwash Lines and Recep.
Elecirica! Final
Heater and Vent Final _
Fil' �ystem Final .
Backwash and Recep, final
�
Fencing Final I / I J
� �—T�'� t-_-r,
VALU
SUBCONTRACTOR
Electric
Plumbing
7 `GS /— / / �C�� ."
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. COSTA MESA BUILDING-SAFETY.DEPARTMENT
� � P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fdl in Completely — Use Ink Only
B���o�N� 30 �v
ADDRESS
OWNER � ��. �
MAIL �7 n � /�i
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CITV
BRANCH
ADORESS
AFCHITEI
ADDRES�nv� ��g AQ'�i
CITV����/�� N��/
STATE � CITY
LIC. NO. p � LIC. NO.
S12E NO.OF BLDGS.
OF LOT NOW ON lOT
VSE OF
EXISTING eLDG.
Separate permits are required for
electric, plumbing and heating work.
USE OF BVILDING AND WORK TO BE PERFOFiMED
f
1 hereby ecknowlatlBe thet � heve reatl Mis appllcetion antl stata
that the abova Information Is correct any epree to comply with
all lews reBulatlnB buildinp construction, and 1 ahall not employ
eny Derwn In vlolotlon of <he workmen's compenaation laws of
the State of Celifornie.
i hareby certify ihei 1 em properly Iicansatl as a connactor untler
the Stefe ot Cellfornia eusinesa entl Professlons Cotla, DIvlslon 3,
Chepier 9, antl that such Ilcansas ere in f�ll force end effeci, or I
am exempt from Ma provleions ot 1 e State of Celifornla Businecs
antl Professions e, Divlsion 3, ��pier 9. t
Siqnat�re af '
Pe�mlttee
Authorized Agent
PAI� .p �44*ir
AUG 19-77�nsu�O1706 4Z.
APPLICATION FOR STRUCCURAL PERMIT
RECEIy� �y DATE FECEIVED ��tF ISHUFe
BUILDING
ADDRES:
OWNER
FIflE
ZONE
APPROVED
) — / NO.OP'
pLqf�LSO
VARDS APPROVED
MAIN BUILDING
ROM C/LSTqEET)
VAR. qW
.� VAL�
$
GFOUP `
DATE
USE OF NE��
BUILDING (_
VARDSAPPROV
DATE
APPROVED
THE/AMOUNTSMOWN UNDER VALUAT
THE PURPO6E OF ESTABLISHING A PERMIT
VALUATION PERMIT FEE E `
PLAN CHECK E
$ ��DO TAX E
TOTAL PAIO E
N
n
m
i
:
m
N
IS FOR m
ONLV: �
oD N
Q m
m
0
1 B u